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Upon submitting this form, I make application for myself and/or child to participate in the Howard County General Hospital Wellness Center event(s) checked below. In consideration for being accepted and permitted to participate in this program, I do hereby, both for myself, my heirs, administrators, executors, and assigns, grant unto the Howard County General Hospital, Inc., and its servants, agents, employees, and any other representatives, a complete release and discharge of and from any and all claims and demands of any nature whatsoever, which I may now have or which I may have in the future resulting from or pertaining or incidental to my acceptance and participation of myself/child in said program, including, without limitation or restriction, any and all claims and demands for illness, injury, or occurrence whatsoever and I do hereby expressly waive and renounce any and all such claims and demands.
Furthermore, in consideration of myself/child being accepted and permitted to participate in said Program, I do hereby voluntarily and knowingly assume any and all risks of injury or damage, which he/she might suffer as a result of my participation in said Program.
I further declare that I have read the foregoing carefully and am fully aware of all the circumstances and ramifications connected with the subject of this Release, Discharge, Waiver, Assumption, and Renunciation.